British journal of anaesthesia
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Accurate measurement of core temperature is a standard component of perioperative and intensive care patient management. However, core temperature measurements are difficult to obtain in awake patients. A new non-invasive thermometer has been developed, combining two sensors separated by a known thermal resistance ('double-sensor' thermometer). We thus evaluated the accuracy of the double-sensor thermometer compared with a distal oesophageal thermometer to determine if the double-sensor thermometer is a suitable substitute. ⋯ The new double-sensor thermometer is sufficiently accurate to be considered an alternative to distal oesophageal core temperature measurement, and may be particularly useful in patients undergoing regional anaesthesia.
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We previously described a convection warming technique (Cassey J, Armstrong P, Smith GE, Farrell PT. Paediatr Anaesth 2006; 16: 654-62). This study further analyses the children in that original study with three aims: (i) to investigate factors purported to influence children's heating rates, (ii) to describe the most effective usage of this warming technique, and (iii) to understand better the physiology of convection warming. ⋯ (i) Although the effectiveness of this warming technique is influenced by patient/procedure characteristics, these do not predict normothermia (uncertainty +/-28 min). Effectiveness is independent of simple thermal measures. (ii) Previously described measures of vasoconstriction are not valid in children. (iii) Our model shows children's thermal properties change with their T(core). However, key factors are unknown for an individual and our model does not predict heating efficacy. (iv) To minimize the risk of hyperthermia, we recommend continuous measurement of T(core) during convection heating. The device air temperature should be turned to medium (38 degrees C) as T(core) approaches 37 degrees C.
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Randomized Controlled Trial
Propofol consumption and recovery times after bispectral index or cerebral state index guidance of anaesthesia.
We compared the propofol requirements and recovery times when either the bispectral index (BIS) monitor or the cerebral state monitor (CSM) is used to guide propofol anaesthesia. ⋯ Compared with BIS, propofol anaesthesia guided with CSI resulted in 20% higher propofol doses. This, however, does not lead to clinically relevant differences in recovery times.
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The pulse pressure variation (PPV) index has been shown to be a reliable predictor of fluid responsiveness (FR) in a variety of clinical settings. However, it has not been formally evaluated in the setting of orthotopic liver transplantation (OLT). ⋯ Under the conditions of this study, the PPV index was not shown to be a reliable predictor of FR during OLT. Further studies are warranted to elucidate the role of this and other dynamic indexes in this specific setting.